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A college sophomore is found by his roommate to be poorly responsive and brought to the emergency department. After resuscitation, the man complains of a severe headache and photophobia that is accompanied by dizziness, nausea, vomiting, and neck pain. Physical examination is noteworthy for positive Kernig and Brudzinski signs as well as petechiae on the trunk and mucocutaneous bleeding. Laboratory studies show:
WBC count: 17,000/mm³
Hemoglobin: 8 g/dL
Platelet count: 70,000/mm³
Bleeding time: 10 min
Prothrombin time: 17 sec
Activated partial thromboplastin time: 47 sec
Thrombin time: 18 sec
A peripheral blood smear is shown in the image.
Which of the following is the most likely diagnosis?
A. Disseminated intravascular coagulation
B. Factor V Leiden
C. Idiopathic thrombocytopenic purpura
D. Protein C deficiency
E. Thrombotic thrombocytopenic purpura
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